title: Gastrointestinal non colorectal cancer. Do elderly patients need a specific management?
abstract: BACKGROUND
  Elderly patients (65 years and over) develop often, sometimes predominantly , esophageal, gastro esophageal junction, gastric and pancreatic cancer (gastrointestinal non colorectal cancer). Most clinical trials exclude elderly patients from accrual considering aging a potential risk factor. In fact an elderly patient can develop greater toxicity than a younger patient from oncologic treatments (chemotherapy, radiotherapy, target therapies) due to a worse function of vital organs.
  
  
  METHODS
  We analyzed the current scientific literature, searching articles since 1990, about gastrointestinal non colorectal cancer in elderly patients, to establish if they need a specific management, different from younger patients.
  
  
  RESULTS
  Data from analyzed studies, both gastro esophageal and pancreatic cancer, are contradictory. In some reports elderly patients don't seem to bring greater toxicity than younger. Other trials consider that dose-adjustment to renal function is need in elderly patients, but these trials are very few. Other trials may include several biases such as accrual of "only fit" elderly patients.
  
  
  CONCLUSIONS
  It is very important in elderly patients with higher risk of toxicity, to distinguish the aim of cancer treatment: is it curative or palliative? Furthermore, in this type of patients the most important target is probably maintaining the quality of life especially in gastric and pancreatic cancer that often started as advanced disease. For these valuation chronological age alone is not sufficient. Another very important factor in elderly cancer patients is the geriatric assessment including not only age but also functional, social and mental status.
authors.affiliation: Department of Abdominal Oncology, National Cancer Institute "G. Pascale"- Via M.Semmola, 80131 Naples, Italy. l.silvestro@istitutotumori.na.it.
authors.forename: Lucrezia
authors.initials: L
authors.lastname: Silvestro
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Nasti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ottaiano
authors.forename: Massimo
authors.initials: M
authors.lastname: Montano
authors.forename: Rossana
authors.initials: R
authors.lastname: Casaretti
authors.forename: Antonio
authors.initials: A
authors.lastname: Avallone
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Berretta
authors.forename: Carmela
authors.initials: C
authors.lastname: Romano
authors.forename: Antonio
authors.initials: A
authors.lastname: Cassata
authors.forename: Salvatore
authors.initials: S
authors.lastname: Tafuto
authors.forename: Rosario Vincenzo
authors.initials: RV
authors.lastname: Iaffaioli
mesh_terms: D000368:Aged; D015577:Geriatric Assessment; D006801:Humans; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000628:therapy*; D011788:Quality of Life; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000628:therapy*